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For patients whose spleen and stomach are weak and fail to generate blood, one cannot solely rely on Siwu Tang (Four Substances Decoction). Therefore, Dr. Li uses Sijunzi Tang (Four Gentlemen Decoction) here to strengthen the spleen and assist the source of qi and blood generation, allowing qi and blood to generate naturally. The formula simultaneously uses Cuscutae Semen (Tusizi), Taxilli Herba (Sangjisheng), Dipsaci Radix (Xuduan), and Eucommiae Cortex (Duzhong) to tonify the kidney and secure the fetus, reflecting the view that securing the fetus must not be separated from benefiting the kidney. When qi is abundant and blood is sufficient, the fetus receives the bearing of qi and nourishment of blood, and is firmly anchored by kidney qi; thus it develops fully, smoothly passes through the gestation period, and is delivered at term.

"Symptoms that are mild manifest as restlessness during movement, while severe cases inevitably lead to miscarriage." Therefore, in treating Tai Lou (threatened abortion with vaginal bleeding) and Tai Dong Bu An (restless fetus with lower abdominal pain and backache), one must dynamically observe the degree of lower abdominal and lumbar pain and the amount of vaginal bleeding to distinguish between impending miscarriage and completed miscarriage. Dr. Li follows the method from *Yizong Jinjian · Men on Diseases Before Childbirth*: for impending miscarriage, strive to reverse the downward trend, greatly tonify qi and blood, tonify the kidney, and secure the fetus; for completed miscarriage, regulate qi and invigorate blood, secure the kidney, and stop bleeding; if bleeding persists and there is a risk of qi and blood collapse, use Dushen Tang (Single Ginseng Decoction) for vigorous tonification of qi and blood; if evil blood is stagnant and fails to move, causing distending pain in the hypochondrium and abdomen, and the condition is excess and acute, use Huisheng Dan (Revival Pill); if the condition is deficiency and chronic, Yimu Wan (Motherwort Pill) is appropriate.

Postpartum Diseases
Postpartum diseases are divided into broad and narrow senses.
Most physicians believe that postpartum diseases refer to illnesses occurring in the puerperium related to childbirth or the confinement period. Dr. Li considers this definition too narrow, as it does not encompass all clinical presentations. He believes that any disease occurring after childbirth, regardless of whether the duration is short or long, falls under this category, including common postpartum diseases and concurrent postpartum conditions, such as Postpartum Blood Collapse (Chou Beng), Postpartum Wind Stroke (Zhong Feng), and Postpartum Bedridden Asthenia (Ru Lao). Additionally, ancient texts state that "miscarriage is more serious than full-term delivery." Clinically, there are indeed cases where various diseases arise due to careless living habits or exposure to external pathogens after induced abortion or miscarriage. Since their syndrome differentiation, treatment, etiology, and pathogenesis are similar to those of postpartum diseases, they are also included in the discussion of postpartum diseases.

Caution with Diaphoresis in Postpartum Cold Damage
In Taiyang Disease, fever, aversion to wind, sweating, and a moderate pulse indicate Wind Strike (Zhong Feng), treated with Guizhi Tang (Cinnamon Twig Decoction) to harmonize Ying and Wei. Aversion to cold, absence of sweating, and a tight pulse indicate Cold Damage (Shang Han), treated with Mahuang Tang (Ephedra Decoction) to release the exterior and induce sweating. However, for postpartum patients suffering from Cold Damage, diaphoresis should be used with caution; forcing sweat is equivalent to damaging blood. Ancient texts state that "sweat and blood share the same source," just as *Nuke Jinglun* says: "Generally, after childbirth, large amounts of blood are depleted; inducing sweat may cause muscle twitching or depression-induced coma... the harm is not slight." Therefore, when treating postpartum Cold Damage, Dr. Li does not rigidly adhere to standard syndromes but always protects against the characteristic postpartum deficiency, avoiding the taboo of "making the deficient even more deficient."

Attached Case:
Wu, Female, 38 years old. Outpatient No.: 56032.
First visit on July 24, 1962: Three months after abortion, despite being summer, she still wore cotton clothes, severely suffered from aversion to cold, had a cool and uncomfortable lower abdomen, no taste for food, preferred abdominal pressure, felt comfortable after eating hot food, tongue coating was thin and white, and pulse was tight. Prescription:
Guizhi (Cinnamon Twig) 7.5g, Sheng Baishao (Raw White Peony Root) 7.5g, Shengjiang (Fresh Ginger) 3g, Fuzi (Prepared Aconite Root) 3g, Dazao (Jujube Fruit) 4 pieces, Zhigancao (Honey-fried Licorice Root) 4.5g.
Second visit: After taking the above medicine, aversion to cold significantly decreased, and she changed from cotton clothes to wool sweaters. Change Fuzi to 4.5g in the previous prescription, take another 2 doses.
Third visit: Aversion to cold has disappeared, and lower abdominal cold pain has reduced by more than half. Take the previous prescription for another 2 doses.
Commentary: This case is Postpartum Cold Damage, a syndrome of cold in both the exterior and interior. The formula uses Guizhi Tang to harmonize Ying and Wei, release the muscle layer, and expel from the exterior. Fuzi assists Guizhi in supporting Wei Yang to release the exterior, while warming Stomach Yang and warming the Uterus, achieving simultaneous treatment of exterior and interior, and precise medication matching the syndrome. In the second visit, the dosage of Fuzi was increased to ensure the disease is eradicated. The medication in this case is concise yet effective, worthy of reference by later generations.

Postpartum Lochia Discharge Continues Indefinitely: Treatment Should Focus on Nourishing and Harmonizing Blood
When lochia continues dripping for more than 20 days after childbirth, it is called "Lochia Discharge Continues Indefinitely" (Elu Bu Jue). This is caused by pathology in the Chong and Ren meridians and abnormal qi and blood circulation. Since lochia is derived from blood, its pathology involves either deficiency or internal blood stasis. Therefore, treatment should primarily focus on nourishing and harmonizing blood. Clinically, Dr. Li often differentiates the severity of deficiency, excess, cold, and heat based on systemic symptoms and pulse-syndrome combinations. He may emphasize nourishing blood, emphasizing invigorating blood, or balancing both, applying them flexibly according to the syndrome and patient. This ensures harmony of qi and blood, security of the Chong and Ren meridians, expulsion of old blood, generation of new blood, and eventual recovery.

Attached Case:
Hao, Female, 30 years old. Outpatient No.: 30905.
First visit on June 15, 1960: The patient had a constitutionally weak body. At 72 days postpartum, lochia did not stop, accompanied by distending pain in the lower abdomen and breast distension. Tongue coating was thin and white, pulse was deep and fine. Prescription:
Danggui (Angelica Sinensis Root) 9g, Chuanxiong (Ligusticum Rhizome) 6g, Chao Baishao (Stir-fried White Peony Root) 7.5g, Ejiao (Donkey-hide Gelatin) 4.5g, Hei Aiye (Black Mugwort Leaf) 4.5g, Xiangfu (Cyperus Rhizome) 4.5g, Wulingzhi (Trogopterus Dung) 4.5g, Hei Puhuang (Black Typha Pollen) 4.5g, Jineijin (Chicken Gizzard Lining) 4.5g, Zhigancao (Honey-fried Licorice Root) 3g.
2 doses, decocted in water and taken orally.
Commentary: The patient's body was constitutionally weak, and she lost blood during and after childbirth, leading to deficiency and damage to the Chong and Ren meridians, hence the continuous lochia. Analyzing her systemic symptoms, the distending pain in the lower abdomen and breasts indicates Qi stagnation and Blood stasis in the Liver meridian; the deep and fine pulse indicates deficiency. Overall, the syndrome is deficiency predominant over excess. Thus, treatment focuses on nourishing blood primarily and invigorating blood secondarily. The formula uses Jiao'ai Siwu Tang to nourish blood and stop bleeding, and Shixiao San to invigorate blood and stop bleeding. Dihuang is removed to avoid harming the stomach and obstructing the chest. Xiangfu regulates the Liver and moves Qi, and Jineijin eliminates accumulation, serving as preventive treatment for potential gastric weakness and accumulation. The entire formula achieves the effect of nourishing and harmonizing blood; although the herbs are few, the efficacy is comprehensive, targeted, and focused.

Postpartum Abdominal Pain: Syndromes Are Often Mixed
Incorporating Attack within Tonification, Incorporating Tonification within Elimination
Postpartum abdominal pain is mainly characterized by lower abdominal pain by most physicians. Following the teachings of *Yizong Jinjian*, Dr. Li believes the pathology of this disease affects the upper, middle, and lower abdomen, not limited to the lower abdomen. Syndromes are divided into deficiency and excess, as discussed in *Jingyue Quanshu · Regulations for Women*: "Postpartum abdominal pain requires careful differentiation of deficiency and excess... Rejection of pressure and inability to tolerate touch indicate excess diseases, suitable for moving and dispersing methods; preference for rubbing/pressing or relief after eating indicates deficiency diseases, and pushing/purging agents should not be used recklessly." However, purely deficient or purely excess cases are rare in clinical practice; mixed cold and heat, or deficiency-excess complex cases are common. Treatment should not forget the postpartum context nor be constrained by it. Deficiency is tonified, excess is attacked; when attacking, consider deficiency; when tonifying, consider excess. Treatment must be tailored to the syndrome and the individual.

Attached Case:
Case 1 Zhang, Female, 38 years old. Outpatient No.: 35926.
First visit on August 22, 1961: Poor appetite for 2 months postpartum, discomfort in the epigastrium, nausea, aversion to cold drinks, tongue coating thin and white, pulse deep, slow, and sluggish. Prescription:
Dangshen (Codonopsis Root) 7.5g, Sheng Baizhu (Raw Atractylodes Macrocephala Rhizome) 7.5g, Fuling (Poria) 6g, Chenpi (Aged Tangerine Peel) 7.5g, Banxia (Pinellia Tuber) 7.5g, Sharen (Amomum Fruit) 4.5g, Caodouren (Cardamom Seed) 4.5g, Jineijin (Chicken Gizzard Lining) 6g, Shengjiang (Fresh Ginger) 3 slices, Zhigancao (Honey-fried Licorice Root) 3g, Guangmuxiang (Costus Root) 6g.
2 doses, decocted in water and taken orally.
Second visit: Previous symptoms significantly reduced after taking the prescription. Continue with the original prescription for another 2 doses, resulting in recovery.
Commentary: Two months postpartum, epigastric discomfort belongs to abdominal pain occurring during the puerperium. It results from depletion of qi and blood after childbirth, compounded by dietary injury, leading to Spleen deficiency and failure of transportation. The aversion to cold drinks indicates interior cold. Thus, the syndrome is deficiency-cold, located in the Spleen and Stomach. Treatment uses Xiangsha Liujunzi Tang to strengthen the Spleen and benefit Qi, assisted by a small amount of Caodouren to strengthen and warm the Spleen, Shengjiang to warm the Stomach and stop vomiting, and Jineijin to promote digestion, resolve stagnation, remove blood stasis, and eliminate accumulation. This fully utilizes the formula's ability to eliminate accumulation wherever it exists in the organs and tissues, while addressing the postpartum tendency toward blood stasis.

Case 2 Yang, Female, 30 years old. Outpatient No.: 16246.
First visit on April 16, 1959: Long-term dull pain in the lower abdomen after miscarriage, sallow complexion, subjective feeling of internal heat in the afternoon, headache, dizziness, tongue coating thin and white, pulse fine and wiry. Prescription:
Danshen (Salvia Miltiorrhiza Root) 15g, Sheng Baishao (Raw White Peony Root) 9g, Chishao (Red Peony Root) 9g, Guiwei (Tail of Angelica Sinensis Root) 6g, Chaihu (Bupleurum Root) 3g, Xiangfu (Cyperus Rhizome) 4.5g, Wulingzhi (Trogopterus Dung) 6g, Sheng Puhuang (Raw Typha Pollen) 6g, Chenpi (Aged Tangerine Peel) 7.5g, Banxia (Pinellia Tuber) 7.5g, Gancao (Licorice Root) 4.5g.
Decocted in water, 4 doses.
Commentary: Due to miscarriage, the uterine collaterals were damaged, causing internal blood stasis and pain due to obstruction ("blockage causes pain"), hence lower abdominal pain. Internal heat in the afternoon indicates that long-standing blood stasis has become dry blood. The wiry pulse governs the Liver and pain. The Liver governs Qi, and Blood is the mother of Qi; blood stasis leads to Qi stagnation. The head is the meeting place of all Yang meridians; when pathogens ascend along the meridians, dizziness and headache occur. The sallow complexion is a sign of deficiency, inconsistent with other pulse and syndrome signs. Observing that excess signs predominate, treatment focuses primarily on invigorating blood and relieving pain, with secondary emphasis on soothing the Liver and regulating Qi. Once stasis is resolved and new blood is generated, the face will regain luster, and the syndrome will be eliminated. Chenpi and Banxia are added to regulate Qi and descend rebellious Qi, embodying the principle of "seeing Liver disease, knowing it transmits to the Spleen, and fortifying the Spleen first," reflecting the idea of preventing disease before it arises.

Postpartum Body Pain Should Be Treated by Addressing Deficiency at the Root
Postpartum body pain refers to pain, numbness, and heaviness in the limbs after childbirth. Because qi and blood are depleted postpartum, the sinews and vessels, as well as the uterine collaterals, lose nourishment, causing pain due to lack of nourishment ("lack of nourishment causes pain"). Alternatively, during a time of emptiness in the joints, exposure to Wind, Cold, and Damp pathogens causes them to linger in the collaterals and joints, resulting in disease due to deficiency and stagnation. Regardless of whether it is Blood deficiency, Kidney deficiency, or invasion by external pathogens, the root lies in insufficient qi and blood. Seeking the root in treatment means focusing on tonifying deficiency for this disease. As stated in *Shen Shi Nu Ke Ji Yao Jian Zheng*: "This syndrome is mostly due to Blood deficiency and should be nourished. If there is Bi syndrome mixed with Wind, Cold, and Damp, nourishing Blood is primary, with slight addition of methods to unblock collaterals." Dr. Li believes that tonifying deficiency can be achieved by directly tonifying qi and blood, strengthening the Spleen to aid the source of transformation, or tonifying the Kidney to benefit essence and blood. Multiple approaches can be taken to achieve the same goal. For Blood deficiency, modify Guipi Tang (Restore the Spleen Decoction); for Wind-Cold, use Siwu Tang to directly tonify blood, add Sheng Huangqi (Raw Astragalus Root) and Honghua (Carthamus Flower) to tonify Qi and invigorate Blood to generate Blood, and use Qin Jiao (Gentian Root), Fangfeng (Saposhnikovia Root), Guizhi (Cinnamon Twig), Sangzhi (Mulberry Twig) and other Wind-expelling drugs, reflecting the thought of "treating Wind by first treating Blood"; for Kidney deficiency, differentiate Yin and Yang. For Yin deficiency with heat, use Liuwei Dihuang Tang (Six-Ingredient Rehmannia Pill) plus Gouqi (Goji Berry) and Niuxi (Achyranthes Root); for Yang deficiency, use Bawei Dihuang Tang (Eight-Ingredient Rehmannia Pill) plus Gusui Bu (Drynaria Rhizome), Buguzhi (Psoralea Fruit), Xuduan (Dipsacus Root), and Duzhong (Eucommia Bark).

Attached Case:
Case 1 Wang, Female, 31 years old. Outpatient No.: 55054.
First visit on April 11, 1963: Numbness in hands and feet, fatigue, lower abdominal pain, poor appetite, and dream-disturbed sleep for 2 months after miscarriage. Tongue coating thin, pulse deep and fine. Prescription:
Dangshen (Codonopsis Root) 7.5g, Baizhu (Atractylodes Macrocephala Rhizome) 7.5g, Zhi Huangqi (Honey-fried Astragalus Root) 6g, Danggui (Angelica Sinensis Root) 7.5g, Fushen (Poria with Hostwood) 7.5g, Yuanzhi (Polygala Root) 6g, Chao Zaoren (Stir-fried Jujube Seed) 15g, Guangmuxiang (Costus Root) 3g, Yuanrou (Longan Aril) 6g, Guizhi (Cinnamon Twig) 4.5g, Sheng Baishao (Raw White Peony Root) 7.5g, Zhigancao (Honey-fried Licorice Root) 3g.
Second visit: After taking 2 doses of the above prescription, appetite increased, sleep improved, and numbness in hands/feet and abdominal pain decreased. Continue with the previous prescription.
Commentary: This case is due to blood loss from miscarriage, causing sinews and vessels to lose nourishment, belonging to Blood deficiency syndrome. The formula uses Yangxue Guipi Tang to strengthen the Spleen and nourish Blood, adds Guizhi to warm and unblock the collaterals, combined with Sheng Baishao to nourish Blood and soften the Liver, benefiting the sinews and vessels, and to counteract the drying nature of Guizhi.

Case 2 Jin, Female, 32 years old. Outpatient No.: 37682.
First visit on December 5, 1961: Exposed to Wind while sweating 40 days postpartum, experiencing stabbing body pain for 3 years. Tongue coating thin and white, pulse deep and powerless. Prescription:
Danshen (Salvia Miltiorrhiza Root) 9g, Danggui (Angelica Sinensis Root) 9g, Chuanxiong (Ligusticum Rhizome) 6g, Baishao (White Peony Root) 7.5g, Sheng Huangqi (Raw Astragalus Root) 4.5g, Zhimu (Anemarrhena Rhizome) 4.5g, Qianghuo (Notopterygium Rhizome) 4.5g, Duhuo (Angelica Pubescens Root) 4.5g, Qin Jiao (Gentian Root) 4.5g.
3 doses, decocted in water and taken orally.
Second visit: Body pain reduced after taking 3 doses of the above prescription. Continue with the previous prescription for 12 doses, resulting in near recovery.
Commentary: The patient was exposed to Wind pathogens while sweating and pores were open 40 days postpartum. Pathogens lodged in the collaterals and failed to leave, persisting for 3 years without healing. Dr. Li did not use methods to search for and eliminate Wind pathogens here. Instead, he used Danggui, Chuanxiong, and Baishao from Siwu Tang to nourish Blood, and Huangqi to tonify Qi to assist Blood circulation, achieving the effect of "when Blood flows, Wind extinguishes itself." Zhimu controls the fierce nature of Qianghuo and Duhuo, preventing their drying nature from injuring Yin. The entire formula primarily nourishes Blood, slightly assists Danshen to unblock collaterals, gently expels Wind, and protects the physiological characteristics of the postpartum state.

Insight on Using Da Chaihu Tang to Treat Puerperal Fever
The patient had fever after childbirth. Western medicine diagnosed it as Puerperal Fever. Antipyretics and antibiotics had little effect. Diagnosis revealed paroxysmal alternating chills and fever, thick yellow tongue coating, abdominal tenderness upon pressure, and constipation for 4 days. This is a typical Da Chaihu Tang (Major Bupleurum Decoction) syndrome. Since it was during the dog days of summer, the intention of Zengsun Da Chaihu Tang (Modified Major Bupleurum Decoction) was applied. To the original Da Chaihu Tang formula, Lianqiao (Forsythia Fruit), Chan Tui (Cicada Slough), and Jiangcan (Bombyx Batryticatus) were added. Because it was postpartum, Danggui (Angelica Sinensis Root) and Taishen (Pseudoginseng Root) were also added. Symptoms alleviated after just 1 dose. Although this case is undoubtedly a Da Chaihu Tang syndrome, due to special factors like the patient's condition and season, applying this formula required considering both the postpartum deficiency and the gastrointestinal stagnation requiring purgation, as well as seasonal climate factors. By adding herbs according to symptoms based on the individual (constitution) and season (climate), precisely and meticulously, effectiveness was achieved promptly. In diagnosing and treating diseases, regardless of the situation, such comprehensive consideration should always be applied.